High-power short-duration ablation of the superior vena cava - Safety and efficacy using the right superior pulmonary vein roof as a landmark

Sep 28, 2026

Uploaded by jayni

High-power short-duration ablation of the superior vena cava (SVC) is assessed as an atrial fibrillation strategy, targeting a common non-pulmonary vein trigger site while reducing procedure-related hazards near the sinoatrial node. A retrospective cohort of 110 patients with paroxysmal AF undergoes circumferential pulmonary vein isolation plus SVC isolation, using the right superior pulmonary vein roof and SVC junction as anatomical landmarks. The study evaluates safety and efficacy with definitions of the electrical sinoatrial node and compares outcomes across mapping groups, reporting successful completion and low transient phrenic nerve injury.

LanguageEnglish

CategoryHealthcare

FormatPDF

Pages8

Reading Time20 min

AccessFree to download

Abstract

Background

Methods

Study population

Results

Conclusion

Yin et al. BMC Cardiovascular Disorders (2025) 25:904 BMC Cardiovascular Disorders [https://doi.org/10.1186/s12872-025-05361-9](https://doi.org/10.1186/s12872-025-05361-9) RESEARCH Open Access High-power short-duration ablation of the superior vena cava: safety and efficacy using the right superior pulmonary vein roof asa landmark Jianlong Yin 1, Hualong Li 1, Zhongpeng Du 1, Jian Liang 1 and Teng Li 1* Abstract Background The superior vena cava (SVC) is a common non-pulmonary vein trigger site in atrial fibrillation (AF), and its ablation improves treatment success rates. However, conventional SVC ablation carries risks of sinoatrial node injury (SNI) and phrenic nerve injury (PNI) due to its anatomical proximity to the sinoatrial node. This study evaluated the safety and efficacy of high-power short-duration (HPSD) ablation of the SVC using the right superior pulmonary vein roof (RSPV roof ) as an anatomical landmark to minimize complications. Methods This retrospective study analyzed 110 patients with paroxysmal AF who underwent circumferential pulmonary vein isolation (CPVI) combined with SVC isolation (SVCI) . The RSPV roof and SVC junction were used as anatomical landmarks. HPSD ablation (50 W/7 s) was performed without phrenic nerve(PN)mapping. The electrical sinoatrial node (eSAN) was defined as the highest point of the earliest activation site during sinus rhythm mapping. Patients were divided into an eSAN-mapped group (n = 50) and a non-eSAN-mapped group (n = 60) . Safety and efficacy outcomes were compared between groups. Results The median age was 60.0 years (IQR: 52 .0–69. 0), with 65 males (59 . 1%) . SVCI was successfully completed in all patients. The median height from the SVC-RA junction to the RSPV roof was 15.1 mm (IQR: 13.5–17.1 mm), with no significant difference between groups. Only one case of PNI occurred in each group, both resolving within 1–2 months. Other complications included pericardial effusion (10 . 9%) and hematoma (2 . 7%) . No SNI, cardiac tamponade, organ embolism, arteriovenous fistula, or mortality was observed. Conclusion Using the RSPV roof and SVC junction as anatomical landmarks for SVC isolation may offer a safe and effective approach. Additionally, HPSD ablation (50 W/7 s) of the SVC was achieved without the use of routine PN mapping in this cohort, resulting in successful isolation and a low incidence of transient PNI. This suggests it may represent a potential alternative strategy; however, the occurrence of PNI underscores that techniques such as PN mapping remain crucial for risk mitigation. *Correspondence: Teng Li[gdmc99@163.com](gdmc99@163.com) Full list of author information is available at the end of the article © The Author(s) 2025. Open Access This article is licensed under a Creative Commons Attribution-NonCommercial-NoDerivatives 4.0 International License, which permits any non-commercial use, sharing, distribution and reproduction in any medium or format, as long as you give appropriate credit to the original author(s) and the source, provide a link to the Creative Commons licence, and indicate if you modified the licensed material. You do not have permission under this licence to share adapted material derived from this article or parts of it. The images or other third party material in this article are included in the article’s Creative Commons licence, unless indicated otherwise in a credit line to the material. If material is not included in the article’s Creative Commons licence and your intended use is not permitted by statutory regulation or exceeds the permitted use, you will need to obtain permission directly from the copyright holder. To view a copy of this licence, visit [http://creati](http://creati)[vecommons.org/l](vecommons.org/l)icenses/by-nc-nd/4.0/. Yin et al. BMC Cardiovascular Disorders (2025) 25:904 Page 2 of 8 Keywords Atrial fibrillation, High-power short-duration, Phrenic nerve injury, Sinoatrial node injury, Right s

FAQs

What anatomical landmarks were used for SVC isolation in the study?

The right superior pulmonary vein roof and the SVC junction were used as anatomical landmarks to guide the ablation while minimizing complications.

How was high-power short-duration (HPSD) ablation performed and what monitoring was included?

HPSD ablation was delivered at 50 W/7 s without routine phrenic nerve mapping, while the electrical sinoatrial node was defined based on sinus rhythm activation mapping.

What were the main safety outcomes reported?

SVC isolation was completed in all patients, with no sinoatrial node injury observed. Phrenic nerve injury occurred in one case per group and resolved within 1–2 months, alongside low rates of pericardial effusion and hematoma.

Sep 28, 2026

Uploaded by jayni